| NPI | 1295363570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 025784) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 25784) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2023-07-03 |